Usefulness of cranio-dorsal approach for laparoscopic left lateral sectionectomy
Usefulness of cranio-dorsal approach for laparoscopic left lateral sectionectomy
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DOI：
10.1007/s13304-023-01502-x
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发表时间：
2023-04-15
影响因子：
2.6
通讯作者：
Ohtsuka，Takao
中科院分区：
文献类型：
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作者：
Kawasaki，Yota;Yamasaki，Yoichi;Ohtsuka，Takao
大多数外科医生使用尾侧-外周入路（C-P入路）进行腹腔镜左外侧部分切除术（Lap LLS）。然而，最近，颅背入路（C-D入路）由于其防止劈裂损伤的优点而被应用于各种类型的肝切除术。目前尚无研究比较使用每种方法行腹腔镜LLS的围手术期结局。因此，本研究旨在通过比较C-P入路与C-D入路的围手术期结局，确定C-D入路是否适用于腹腔镜LLS。回顾性收集了2010年至2022年期间在我们机构接受Lap LLS治疗肝脏肿瘤的患者数据。我们比较了使用传统C-P入路（在尾周方向横断肝实质）和C-D入路（在头尾方向横断肝实质）行Lap LLS的围手术期结局。所有手术仅由委员会认证的专家外科医生进行，以尽量减少技术偏差。此外，在整个研究期间，我们机构采用的围手术期程序保持不变。共纳入36例患者（C-P入路，n= 25; C-D入路，n= 11）。C-D入路的手术时间显著短于C-P入路（中位数，225 min vs. 262 min，p= 0.04）。此外，C-D入路的失血量显著低于C-P入路（中位数，20 mL vs. 100 mL，p< 0.01）。其他参数，如发病率和住院时间，组间相当。C-D入路手术效果优于传统C-P入路。
Most surgeons perform laparoscopic left lateral sectionectomy (Lap LLS) using the caudo-peripheral approach (C-P approach). However, recently, a cranio-dorsal approach (C-D approach) has been applied to various types of hepatectomy owing to its advantage of preventing split injury. No studies yet have compared the perioperative outcomes of Lap LLS using each approach. Therefore, this study aimed to determine whether the C-D approach is useful for Lap LLS by comparing its perioperative outcomes with the C-P approach. Data of patients who underwent Lap LLS in our institution between 2010 and 2022 for liver tumors were retrospectively collected. We compared the perioperative outcomes of Lap LLS using a conventional C-P approach, which transects hepatic parenchyma in the caudo-peripheral direction and a C-D approach, which transects hepatic parenchyma in the cranio-caudal direction. All surgeries were performed only by board-certified expert surgeons to minimize technical bias. Furthermore, the perioperative procedures employed at our institution remained unchanged throughout the study period. A total of 36 patients were included in the study (C-P approach,n= 25; C-D approach,n= 11). The C-D approach showed a significantly shorter operation time than the C-P approach (median, 225 min vs. 262 min,p= 0.04). In addition, the C-D approach showed significantly lower blood loss than the C-P approach (median, 20 mL vs. 100 mL,p< 0.01). Other parameters, such as morbidity and hospital stay, were comparable between groups. The C-D approach could offer better surgical outcomes than the conventional C-P approach.